Name____________________________________
Address__________________________________
City__________________St_______Zip________
Age_____Sex_____Phone (____) _____-_______
Check Event: ______Run OR ______Walk
E-mail___________________________________ [E-mail addresses will only be used to notify racers of upcoming HHC sponsored races.]
Check Distance: __ Mini __ 10 Mi __ 10K __ 5K
Hoosier Hikers Council Member Rate
______ $10 Pre-registration Donation (No T-shirt)
______ $20 Pre-registration Donation (With T-shirt)
Non-Member Rates
______ $15 Pre-registration Donation (No T-shirt) (Day of race: $20)
______ $25 Pre-registration Donation (With T-shirt) (Day of race: $30)
Family Rate
______ $25 Pre-registration Donation (T-shirts $10 each extra)
Check T-shirt Size: __ S __ M __ L __ XL __XXL
______ $20 Hoosier Hikers Council membership*
______ TOTAL
WAIVER: In consideration of your acceptance of my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Indiana Track Club, the Hoosier Hikers Council, the Indiana Department of Natural Resources, the Counties of Morgan and Monroe, all sponsors and their representatives and successors from all claims or liabilities of any kind arising out of my participation in these club activities.
Signature_____________________________________________ (Parent or Guardian if under 18
Entry fee must accompany entry. Make checks payable to Hoosier Hikers Council.
Mail to: HHC, P.O. Box 1327, Martinsville, IN 46151
*The Hoosier Hikers Council is a fully tax deductible 501 (c) 3 non-profit organization.